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Wednesday, 16 May 2012

Exercise and Migraine

I looked at my watch. Shit. I was running
ten minutes late. I abhor being late, I’m one of those people who would rather
be half an hour early for an appointment than even five minutes late. I slammed
the front door behind me and prayed that I wouldn’t have to wait too long for a
bus.

I made my way onto the main road, power
walking toward the bus stop which was now just three blocks ahead, I turned
round to look down the road to see if a bus was approaching. There is always
that moment of horror when you either see a bus just leaving the bus stop, or
see one approaching but know you’ll never make it to the bus stop in time. I
couldn’t see a bus so kept on power walking. I swiveled round again, a risky
move considering vertigo used to be a big problem for me and I have a ‘dodgy’
neck (very technical medical term) and lo and behold a bus was coming round the
corner. And then something very strange happened. Before I even knew what was
happening my legs were doing something odd. I had broken into a sprint! I was
running! To put this into context, I have not officially been jogging, or done
any real aerobic exercise since 2004. Yet, some reflex made me run for my life
to catch that bus, my neck brace was attached to my handbag (I was meant to be
wearing it but because I was late I’d forgotten to put it on.) So here I was
running along the street like a crazy lady, my arms waving frantically at the
driver whilst shouting “Wait for me! Wait for me!” And the driver did wait for
me. I fell into the bus and was so pleased with myself that I did a little
‘Rocky’ victory move, hands above head style, and said out loud to my fellow
passengers, “I made it! Look! I made it!” No one clapped. Obviously, they
didn’t realize quite how momentous this was. I pushed aside a nearby Granny,
knowing I wouldn’t make it to the next available seat, and as the bus set off
wondered if it was too late to qualify for the Paralympics.

And then, whilst sweat seeped out of pores
I didn’t even know existed, panic suddenly set in as I think I experience my
first ever asthma attack. I quickly put on my neck brace and realized the
chances of me being able to stand up and get off the bus were slim. Now you
must be wondering what appointment could possibly be so important that I would
put nearly a whole year of physiotherapy treatment, Doctors appointments, in-patient
injections on torn discs, nerve damage, degenerative and hyper mobile neck
joints, in jeopardy? Well, I was not late for a job interview, nor a work
meeting. I was not late for a date, or even a social engagement of any kind. I
was late… for a manicure.

But I tell you these manicure people can be
mean!! You don’t understand here in the UK they can get nasty. I was once late
for a manicure on my Birthday and they made me cry. Oh how I miss $11
manicures in NYC where you essentially hold hands with a stranger and they
don’t try to make small talk, possibly because they can’t speak English. Anyway, point is, I did not want to be late – and some reflex had taken over to
ensure I wasn’t. And maybe I haven’t been getting out enough due to chronic
migraines so this appointment seemed a little more significant that it really
was (Mum made me add this sentence.)

Anyway, sitting having my beautiful Shellac
manicure (it really does work by the way, the polish does stay on for nearly
2-3 weeks) my 50-yard dash was quickly making itself known. My left shoulder
and hand had gone numb, my shoulder and neck muscles had already turned to rock
and I could feel a mini spasm creep up the back of my neck. In a way it felt as
if my neck was crystallizing, if that makes any sense at all. And, before long
a migraine had set in. This happens every time I do any type of aerobic
exercise. And no, don’t be silly, of course it didn’t occur to me to stop the
manicure and go home. I had made it this far after all.

The above incident, which I now like to
refer to as the ‘manicure migraine’, actually took place a couple of months
ago, but I’ve only just plucked up enough courage to confess. I was not worried
about telling my physiotherapist or the pain specialist / orthopedic physician
who had been giving me nerve blocks and other treatments for the dodgy neck, oh
no, the person I most feared confessing to was Mum. As you can imagine, ‘manicure
migraine’ triggered a mini spate of other migraines and problems. Mum was
slightly bemused as to what was happening, I did my best to fob her off saying
I’d sat in a bad chair the night before (which can trigger migraines for me) but
she didn’t buy it. To re-iterate my stupidity once again, at the time I was
just about to start Prolotherapy (a series of injections down my neck) which
are hopefully going to stop my neck going into spasm which it can do if I tip
my head back to put my hair in a ponytail. I had spent months getting my neck
stable enough for the Prolotherapy and I still ran for the bus! When I finally
did confess to Mum she said:

“I’m completely and utterly shocked.”

“At my total stupidity to put my treatment
in jeopardy and essentially give myself a migraine?”

“No, I’m used to you doing that Darling. I’m shocked that you
could actually physically run. It’s been so long since you’ve done any real
exercise, I didn’t know you could put one foot in front of the other and move.
I’m almost impressed. By the way your nails did look lovely”.

Phew!

So, when people helpfully suggest I do some
vigorous exercise to get rid of my migraines I will now refer them to the ‘manicure
migraine’ incident. But I am not typical of all migraineurs, I also have a type
of cervocigenic headache (headache stemming from neck injury) and I can’t swim
or do yoga at the moment as even these gentle forms of exercises trigger
attacks for me. I look incredibly cool and walk up and down the pool instead,
it’s actually quite hard work. Conversely, sitting in one position for too long
and getting stiff also triggers migraines for me, it’s a tricky balancing act.
But I do fully intend to get back to other forms of exercising one day but at
the moment I can’t. Nearly a year ago, just as I was coming out of a three-day
migraine, my neck went into a mega spasm after I sneezed which triggered a
descent back into chronic migraine land and regular spasms. I had to give up my
part time job and getting healthy again is my current job. And yes, I still ran
for the bus. (But my neck has been doing this for years and its been getting
progressively worse… oh leave me alone!)

So, on a serious note, the debates about
exercise and migraine abound and clearly more research needs to be done. But I
refer you all to the fabulous migraine blog, That M word, for an example of where
building up to regular exercise seems to have worked wonders as a migraine preventative.
For various reasons, migrainuer Emily Guzan decided to come off the daily
preventative Topamax (which I’m currently on) and build up to a very careful
and gradual exercise routine and the results are, so far, astounding. This last
weekend she ran a 5K and has had only one migraine since March 18th! But I’m
sure she’d be the first to say that regular exercise is only one part of
Emily’s migraine preventative life-style. Check out her blog to see what other
techniques she employs.

Interestingly (well I thought so) I
recently read about a 2011 study from a Swedish University in which 91 patients
where divided into three groups. One was put on Topamax, one given relaxation
exercises, and the other given an exercise programme to do three times a week.
After 3 months ALL sets reported a 95% drop in migraine frequency, thus suggesting
that regular exercise might be an equally effective preventative compared to drugs
such as Topamax and relaxation therapy. (Links to full study below.)

So, YOU know your migraine best and it’s a
question of carefully and methodically working out a prevention, lifestyle and
treatment programme as a team with your Doctor. A good start can be to keep a
detailed Migraine Diary (I link to some good ones here.) But for some exercise
is a trigger and for some it works as a fabulous preventative, everyone is
different as is every migraine. And there are many different theories and
reasons as to why exercise can be a trigger, so do some research and talk to
your Doctor. Medical ‘advice’ is generally that a gentle, regular exercise programme
usually works as an effective preventative. Exercising too rigorously,
especially when you’re not use to it, can lead to an ‘exertion’ headache or migraine
and many other factors, such as heat and blood sugar, play a part. The Migraine Trust have a great fact sheet on this topic. Meanwhile, I’ll stick to walking up
and down the pool and doing the floor strengthening exercises my
Physiotherapist prescribes. And Mum has also offered to paint my nails.

Is exercise a trigger or a preventative for
you? Has yoga helped or hindered?

Another great post Victoria. And Emily, I just read yours too. Keep up the good work with the running. I had my longest break ever from migraines when I was training for a triathlon back in 2010. I was probably doing 1-2 hours exercise a day and sleeping and eating really well so overall in a really good routine. I think I went for about 3 months with no migraine. Interestingly, in the 2 weeks before the race as I eased off the training in order to be fresh for racing, I got 2 migraines. Unfortunately since 2010, I've never been able to get back to the same level of fitness as the migraines have always got in the way so my exercise routine is now quite erratic. I think I used to make my migraines worse because I would have 3 days in bed and then would go out and try and run and bike hard the next day and pretend like I was someone who didn't suffer from migraines. Then I fainted during one such run session and bashed my head on the road and that kind of gave me a wake up call that I should perhaps take it a bit easy! But then as my migraines became more and more frequent, I had less and less energy to do exercise on my good days anyway. However, I wonder if I'd been a bit smarter at the beginning and not pushed myself so much, I could have stopped them escalating?

Now I'm on Topamax my energy levels have been affected so much that I can only manage a little yoga (I say yoga, but it is more core strengthening exercises I do - no downward dog for me. I have to be very careful with all the poses I do. I took a one on one class with a very good teacher who specialises in people with pain conditions because I think you have to be careful with yoga triggering your migraines). However, am hoping to start going on short runs and swims soon because I think the effect it has on my mood is so good for me. There is nothing like the endorphin high from a bit of exercise.

I am hating all the side effects from Topamax but I am seeing a slight improvement (reduction of 1-2 days per month) so seeing as it takes so long to get up to the right dose and equally to come off it, I feel I should carry on. However, it is so tempting to jack it in and try the exercise route. At least I wouldn't feel constantly nauseous all the time!!!

Hi Fiona! Well, not sure I've ever done two hours of exercise a day in my life, even before my migraines started! There have been periods over the last 13/14 years when I was in better shape and could do more activities but I also didn't realise the extent of my neck damage so was probably hurting myself without realising it! It sounds like you've worked out that gentle routine could be key for you in regard to exercise (as it seems to be with most things migraine) but I TOTALLY understand what you're saying about the Topamax. It's taken me now 5 months to build up to what our neurologists whats me to be on and its making me quite dopey (and I know I'm on such a small dose compared to you) so I'm not moving around enough, so I get stiff...and then get a migraine.. But I feel like I've come this far it's a shame to give up now! I also recently read about a girl who was on Topamax and noticed that after a year the side effects went away...so nearly half way there! Also, today I was writing out a check (cheque?) and had to ask the woman behind the counter how to spell 'fourty pounds'....I blame the Topamax! I'm thinking of writing myself a daily time table to force myself to get things done x

Great blog post, you know from my Migraine experiences, that mine got worse when I stopped exercising and have improved dramatically since being on Topirimate and training for marathons, all in aid of Migraine trust of course! Now my training has slowed down my side effects are worse, there is def a link but as you say it's different for us all. Hope the nails are pretty xx

The Monologueress

I've had migraines since I was 18. I'm now 21. OK, I'm really 32 but look at least 26. I'm a Writer, mainly dramatic, by this I mean for Theatre and Film/TV. I'm also a Dramaturge (I'll help you with your writing.) Although I have three Masters Degrees I still can't spell properly and have not mastered grammar. Two of my Masters degrees are from American Universities so I get confused between American and British grammar. My big sister says this is not a valid excuse. Did I mention I have bad migraines? I love Musicals. I love Tina Fey. I have long red hair.

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This blog is not intended to be, and should not be construed as being, medical advice or a recommendation to take any medicinal drug. Readers should always seek a professional medical opinion in light of their own symptoms and circumstances.